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HIV INFECTION IS ASSOCIATED WITH A LESS AGGRESSIVE PHENOTYPE OF INFLAMMATORY BOWEL DISEASE. A MULTICENTER STUDY BASED ON THE ENEIDA REGISTRY

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Introduction

The coexistence of immune-mediated diseases and non-pharmacological immunosuppression states are rare and might determine the natural history of the disease and therapeutic decisions of the physician. IBD guidelines recommend screening for human immunodeficiency virus (HIV) before starting immunosuppressive treatment, but data on the impact of HIV infection on IBD and its management in the era of biological drugs are scarce.

Aims & Methods

Aims: Therefore, our aim was to describe the IBD phenotype, immunosuppressive requirements, and prevalence of opportunistic infections (OI) in patients with IBD and coexisting HIV infection.
Methods: Case-control, retrospective, multicenter study including all IBD patients with available HIV serology on the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD –GETECCU). IBD patients with positive HIV serology were selected (HIV+) and compared to HIV seronegative IBD patients (controls), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD. Demographic, clinical IBD characteristics, therapeutic requirements, OI and IBD complications were registered.

Results

Ninety-one HIV+ IBD patients and 273 controls were included. In the whole cohort, 81.3% were men, 58.2% had ulcerative colitis (UC), 35.2% Crohns’ disease (CD) and 6.6% IBD unclassified. Median age at IBD diagnosis was 38 years (IQR 30-48), median age at HIV infection diagnosis was 36 years (IQR 30-42), 49.5% being firstly diagnosed of IBD. Among UC patients, HIV+ had a lower proportion of extensive disease (24.5% vs. 46.5%; P=0.002), and a higher proportion of proctitis (39.6% vs. 15.1%; P<0.001) than controls, without differences on disease proximal progression (11.3% vs. 10%). Among CD patients, HIV+ presented a higher proportion of colonic involvement than controls (40.1% vs. 12.5%, P=0.002) and lower penetrating behavior (9.4% vs. 24%; ns). HIV+ had a lower proportion of extraintestinal manifestations (9.9% vs. 24.9%; P=0.004). Although it was not statistically significant, a trend towards a lower proportion of hospitalizations (25.6% vs. 35.3%) and IBD complications (6.3% vs. 9.2%) in HIV+ was observed. Regarding IBD therapeutic requirements, immunosuppressant (37.4% vs. 57.9%; P=0.001) and biological drugs (26.4% vs. 42.1%; P=0.007) were used less frequently among HIV+ than among controls. Conversely, HIV+ had a higher rate of OI (28.6% vs. 9.5%; P<0.001) and malignancies (13.2% vs. 8.8%, ns) than controls.

Conclusion

The coexistence of IBD and HIV infection seems to be associated with a less aggressive IBD phenotype and a lower use of immunosuppressants and biologicals but with a remarkable rate of OI.

Disclosure

I have served as a speaker, consultant and advisory member for or has received research funding from Takeda, Gilead, Janssen, Faes Farma, FalK and MSD

HIV INFECTION IS ASSOCIATED WITH A LESS AGGRESSIVE PHENOTYPE OF INFLAMMATORY BOWEL DISEASE. A MULTICENTER STUDY BASED ON THE ENEIDA REGISTRY

Margalida Calafat Sard 1, Carles Suria Bolufer 2, Francisco Mesonero Gismero 3, Ruth María de Francisco García 4, Carmen Yagüe Caballero 5, Luisa De la Peña 6, Alejandro Hernández-Camba 7, Ainhoa Marcé 8, Beatriz Gallego 9, NOELIA MARTÍN VICENTE 10, Montserrat Rivero 11, Isabel Iborra colomino 12, Iván Guerra 13, Marta Carrillo Palau 14, Lucía Madero 15, Beatriz Burgueño 16, David Monfort Miquel 17, Gisela Torres-Vicente 18, Marta Teller 19, JUAN ANGEL FERRER ROSIQUE 20, Pablo Vega 21, Cristina Roig Ramos 22, Ángel Ponferrada-Díaz 23, Elena Betoré 24, Yamile Zabana 25, Javier Gisbert 26, David Busquets Casals 27, Noelia Alcaide 28, Blau Camps Aler 29, Jesús Legido Gil 30, Maria González-Vivó 31, Unknown Unknown 32, Isabel Pérez-Martínez 33, Diego Casas Deza 34, Jordi Guardiola 35, Laura Arranz Hernández 36, Mercè Navarro 37, Fernando Gomollón 38, Fiorella Cañete 39, Miriam Mañosa Ciria 39, Eugeni Domenech Morral 40

1 Hospital Universitari Germans Trias i Pujol, Barcelona, Spain|||CIBEREHD, Madrid, Spain

2 Hospital Clínic Universitari de València, Universitat de València, Valencia, Spain

3 Hospital Universitario Ramon y Cajal, Madrid, Spain

4 Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain

5 Hospital Universitario Miguel Servet, Zaragoza, Spain

6 Hospital Universitari de Bellvitge, L'hospitalet del Llobregat, Spain

7 Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

8 Hospital de Sant Joan Despí Hospital Moisès Broggi, Sant Joan Despí, Spain

9 Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria, Zaragoza, Spain

10 Hospital Hospital Universitario de Galdakao, Galdakao, Spain

11 Marqués de Valdecilla Universitary Hospital, Santander, Spain

12 La Fe Universitary and Politecnic Hospital, Valencia, Spain

13 Hospital Universitario de Fuenlabrada, Madrid, Spain

14 Hospital Universitario de Canarias, Islas Canarias, Spain

15 Hospital General Universitario Dr Balmis de Alicante. ISABIAL, Alicante, Spain

16 Hospital Rio Hortega, Valladolid, Spain

17 Consorci Sanitari de Terrassa, Terrassa, Spain

18 Hospital Arnau De Vilanova, Lerida, Spain

19 Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

20 Hospital Universitario Fundación Alcorcón, Alcorcón, Spain

21 Complexo Hospitalario Universitario de Ourense, Ourense, Spain

22 Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain

23 Hospital Infanta Leonor, Madrid, Spain

24 Hospital Universitario San Jorge, Huesca, Spain

25 Hospital Universitari Mútua Terrassa, Terrassa, Spain|||CIBEREHD, Madrid, Spain

26 CIBEREHD, Madrid, Spain|||Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain|||UAM, Madrid, Spain

27 H. DE GIRONA DR. J. TRUETA/ICO GERONA, Girona, Spain

28 Hospital Clínico Universitario de Valladolid, Valladolid, Spain

29 Hospital de Granollers, Granollers, Spain

30 Complejo Asistencial de Segovia, Segovia, Spain

31 Hospital Parc de Salut Mar, Barcelona, Spain

32 Universitat de Valencia, Valencia, Spain|||Hospital Clínic Universitari de València, Valencia, Spain

33 Hospital Universitario Central de Asturias, Oviedo, Spain

34 Hospital Universitario Miguel Servet, Zaragoza, Spain|||Instituto de Investigación Sanitaria de Aragón (IISA), Aragón, Spain

35 Hospital Universitario de Bellvitge, L'Hospitalert de LLobregat (Barcelona), Spain

36 Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain

37 Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain

38 Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain|||CIBEREHD, Madrid, Spain

39 CIBEREHD, Madrid, Spain|||Hospital Universitari Germans Trias i Pujol, Badalona, Spain

40 CIBEREHD, Madrid, Spain|||Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

Event

UEG Week Copenhagen 2023

Topics

IBD Paediatrics

Submission format

Abstract

Session

IBD aetiology

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Presentation

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A clinician's overview of microscopic colitis

Yamile Zabana 1

1 Hospital Universitari Mútua Terrassa, Terrassa, Spain

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Primary Care

Session

Easily overlooked cases of chronic diarrhoea

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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The pathophysiology

Giovanni Barbara 1

1 University of Bologna, Bologna, Italy

Event

UEG Week Berlin 2025

Topics

IBD Primary Care

Session

When IBD and IBS experts collaborate for optimal diagnosis and treatment of IBD with IBS-like symptoms

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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$Surgical treatment for refractory reflux$

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Surgical treatment for refractory reflux

Eric Hazebroek 1

1 Rijnstate Hospital, Arnhem, Netherlands

Event

UEG Week Berlin 2025

Topics

Oesophagus Primary Care Surgery

Session

Managing reflux at multiple levels

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Future trends in diagnosis and management of coeliac disease

Fabiana Zingone 1

1 University of Padua, Padua, Italy

Event

UEG Week Berlin 2025

Topics

Immunology Small Intestine & Nutrition

Session

Coeliac or non-coeliac enteropathy?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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PROTON PUMP INHIBITORS NEGATIVELY IMPACT THE COURSE OF ULCERATIVE COLITIS – A COHORT STUDY OF OVER 10000 NEWLY DIAGNOSED PATIENTS IN NORWAY

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Introduction

Ulcerative colitis (UC) occurs in genetically predisposed individuals. The influence of environmental factors and the gastrointestinal microbiome is thought to be of particular importance in this disorder. Proton pump inhibitors (PPIs) affect the microbiome along the entire GI tract and PPI use is the single factor that influences fecal microbial composition to the largest extent at a population level. Only few studies have previously investigated the association between PPI use and UC, but these suggest that PPIs may increase the risk of UC and possibly also affect the disease course. The objective of the study was to examine how PPI exposure is associated with disease course in a large national cohort of newly diagnosed UC patients.

Aims & Methods

Nationwide data from the Norwegian Patient Registry (NPR) and the Norwegian Prescription Database (NorPD) were linked and a study cohort including all newly diagnosed UC patients in Norway between 2010 and 2020 was drawn based on predefined case definitions. PPI exposure was included as a time dependent variable and defined as PPI dispensal of at least 0.5 defined daily doses for 28 days. A 30 day time lag from dispensal was added and the exposure period extended 60 days after the duration of the prescription. Outcomes were classed by use of advanced therapies (adalimumab, infliximab, golimumab, vedolizumab, ustekinumab and tofacitinib), systemic glucocorticoids, and starting any additional systemic anti-inflammatory medication and colectomy during follow-up. Time-dependent Cox regressions included the variables PPI use (time-dependent), first systemic glucocorticoid prescription (time-dependent), first UC hospitalization (time-dependent), age-groups 0-19, 20-39, 40-59, 60+ years and sex. In the multivariate analyses using systemic glucocorticoids and colectomy as outcomes, advanced therapies was also included as a variable. Patients were followed from time of diagnosis until the outcome of interest, death or December 2020, whichever came first.

Results

There were 10149 patients in the study cohort. The median age was 40 years (IQR 27-56) and 56% were males. PPI use independently increased the risk of starting glucocorticoids (HR 1.20, 95% CI 1.07-1.34), advanced therapies (HR 1.54, 95% CI 1.36-1.73), any additional anti-inflammatory treatment (HR 1.18, 95%CI 1.05-1.32) and undergoing colon surgery (HR 1.52, 95%CI 1.17-1.98). The strongest risk factor for starting glucocorticoids were hospitalization (HR 4.35 95%CI 3.96-4.77), while young age also was a significant risk factor. Use of glucocorticoids was the strongest risk factor for starting treatment advanced therapies (HR 13.19, 95%CI 11.12-15.63) and younger age was also a significant risk factor in this analysis. In the sensitivity analysis using outcomes occurring without time lag and with 60 days lag, the HR of PPI use were similar. In analyses where patients exposed to NSAID were excluded, PPI use remained a significant risk factor for starting advanced therapies HR 1.66 (1.47-1.88) and undergoing colectomy HR 1.64 (1.25-2.15), but PPI use was no longer a risk factor for starting glucocorticoids or starting any anti-inflammatory treatment.

Conclusion

In this national cohort of newly diagnosed patients with UC, PPI use was a risk factor for unfavorable outcomes including advanced therapy initiation, additional anti-inflammatory medications and undergoing colectomy. Although further studies are needed, the evidence suggests that PPIs could affect the course of UC and should be used cautiously in UC patients.

Disclosure

The project was funded by Takeda. The author SSL reports research funding from Takeda during the conduct of the study. RF has received lecture fee from Takeda. MLH reports investigator research grants from Takeda, Pfizer, Tillotts and Ferring, and speaker fees from Tillotts, Ferring, Galapagos, BMS, MSD and AbbVie as well as Advisory board honoraria from Takeda and AbbVie.